Tuberculous otitis media

A case of tuberculous otitis media is being reported. It is a rare infectious disease and remains undiagnosed or confused with other acute or chronic middle ear infections, if appropriate diagnostic studies are not performed. Due to the confusion in the diagnosis of this disease, mild to severe complications develop early.     

Secretory otitis media

Secretory otitis media is a common condition and deafness is liable to be missed in children by their parents. The lack of response from the child may be thought to be due to inattentiveness. Likewise it is liable to be missed during a clinical examination unless specially looked for. An attempt has been made to study the condition particularly with regards to insertion of grommets.     

Secretory otitis media: A school health survey

The present study was carried out to find out prevalence of secretory otitis media in 200 school going children between the age group of 5–7 years by impedance audiometry besides clinical evaluation. 100 children were taken from two different schools catering to higher and lower socioeconomic strata of society. The overall prevalence of secretory otitis media came out to be 20.75%. It was 28.5% in lower socioeconomic group and, 13% in the other group. This high prevalence warrants routine screening for secretory otitis media. Further impedance audiometry was found to be very good method of screening secretory otitis media.     

Intracranial complications of otitis media: In retrospect

Objective

Evaluating intracranial complications of otitis media.

Design

An Evaluative study of 106 cases of intracranial complications secondary to otitis media.

Intervention

Diagnosis is based on history, clinical exam (general, systemic and ENT), investigations hemogram, X-ray mastoid CT scan brain and mastoid.

Treatment

1. Medical management:

1. IV Higher Antibiotics.

1. Surgery for complicating pathology:

1. Pus (in Abscesses)-bram canula aspiration.
2. Lateral sinus thrombosis (thrombus removal),
3. Otitic hydrocephalus (epidural catheterization).

1. Primary disease eradication:

1. Exploration of mastoid.

Results

Fully recovered patients without residual neurodeficit (85%), Morbidity (6%) CSF otorrhoea secondary to otitic hydrocephalus (9%) Mortality: preoperative (3%) and postoperative (6%).

Conclusion

Otological approaches for management of cases of intracranial complications of otitis media are equally comparable with results by neurosurgical approaches of management. Therefore, holding promise if applied in the rural and peripheral parts of India with limited resources even with absence of the expertise of Neurosurgical Department.     

Long term language deficiencies in children with otitis media during their first year of the life

A cohort of lower socio-economic children who experienced multiple and prolonged episodes of otitis media (OM) during their first year of life were compared to an equivalent group of children who were largely free of OM during their first year. Both groups were followed until 9 years of age. The data indicate that children with positive histories of OM performed poorer on a variety of Iinguisitc tasks across the nine year age span than the children with the positive histories of OM. The results suggest that the effect of the otitis media and its accompanying hearing loss on communication skills may extend throughout childhood.     

Telescopic rhinoscopy in chronic secretory otitis media

The recent advances in optics have helped in making newer telescopes which enable better light transmission and magnification, thus facilitating the excellent view of hidden anatomical structures and pathological conditions of the nose which were otherwise impossible.     

Controversies in surgery of chronic otitis media

Controversies in Surgery of Chronic Otifis Media is reviewed.     

Ossicular pathology in unsafe chronic suppurative otitis media

Fifty cases of unsafe chrome suppurative otitis media who underwent mastoid surgery were taken up for the study. All the ossicles in these cases were studied grossly under X6 magnification and fifty two ossicles removed during operation were studied histologically. The gross and histopathological observations of these ossicles are presented.     

Chronic suppurative otitis media in school going children

The morbidity and mortality associated with otitis media is really a challenge for the health care systems. This study is a small attempt to look into the magnitude of this problem in the society, where in school going children in Yavatmal city were studied. A total of 4104 students were studied. It was found that the overall prevalence of chronic suppurative otitis media in Yavatmal city is 3%. The incidence of acute otitis media was found to be 1.3% Chronic suppurative otitis media was commoner in students belonging to low socioeconomic strata and its association with adenoid hypertrophy was statistically significant. The authors recommend that a few more such studies should be carried out in different parts of the country to collect vital data for the health care system managers. Suppurative otitis media, school children, Yavatmal city.     

Audiovestibular profile in unilateral chronic suppurative otitis media

AudioIogical tests including middle ear impedance test and vestibular function tests were administered to seventyfive patients of unilateral chronic suppurative otitis media. These patients were selected so as to exclude the influence of hereditory, drugs, systemic illness and the factors of aging. The subjects were subdivided into 3 groups : group 1 cases with central perforation; group 2 with marginal and group 3 with attic perforation respectively. On pure tone audiometry, 19 diseased ears (25.3%) showed sensorineural hearing loss of 40 dB or more at 4 KHz and 8 KHz. The difference in the mean bone conduction threshold of diseased and the nondiseased ears was statistically significant at 4 KHz and above. Results of specialised tests of hearing suggested cochlear pathology being responsible for sensorneural hearing loss. Electronystagmographic recording of saccades and bithermal caloric induced nystagmus revealed canal paresis on the diseased side in 4 patients (5.3%). These 4 patients had 15 years history of otorrhoea.     

Secondary fungal infections in chronic suppurative otitis media

A clinical, bacteriological and mycological study of 103 cases of ‘safe’ chronic suppurative otitis media with intractable otorrhoea was conducted to observe the role of fungi in the pathogenesis and perpetuation of the disease process. Mycotic otitis media was found in 42 cases (40.77%). 45 patients with draining ears which grew pure bacterial growth were treated with ear drops. Fifteen of these patients were treated with topical antibiotics (polymyxin, Neomycin & Gramicidin). Other 15 patients were put on antibiotic steroid (Polymxin, Neomycin and Hydrocortisone) ear drops. The remaining 15 patients acted as controls with dry mopping treatment only. It was noted that prolonged exposure to antibiotic ear drops and antibiotic-steroid ear drops led to the growth of pathogenic fungi in 5 patients (33.33%) each from two study subgroups while the third control subgroup of 15 patients grew fungi of low virulence in 3 cases (20%). It was concluded that the routine and prolonged use of topical antibiotics or antibiotics-steroids in cases of wet ‘safe’ chronic suppurative otitis media, from the onset is not justified.     

Early detection of tubercular otitis media: A clinicopathological study

Four out of 80 cases admitted for ear surgery had tubercular otitis media. Associated pulmonary tuberculosis and tuberculosis cervical lymphadenitis were present in one case only. Rest three cases had primary tuberculosis of ear. All the four cases were diagnosed by histopathology. Radical mastoidectomy followd by antitubercular treatment was given in all the four cases. Post aural abscess and facial paralysis were present only in one case.In three months follow up, all the four cases had dry ear, facial paralysis recovered but hearing did not improve as tympanoplasty was not attempted in any case. There was no further deterioration of hearing after surgery in any case.     

Chronic suppurative otitis media and sensorineural hearing loss: Is there a correlation?

Traditionally, it has been accepted that chronic suppurative Otitis media is associated with a breakdown in meekanical conduction of sound leading to conductive hearing loss, On;the contrary, there are two schools of thought when it come, to the issue of cpchlear involvement leading to sensorineural hearing loss (SNIIL) in chronic suppura the Otitis media. The present study was undertaken to find out whether a sensorineural component exists in hearing loss associated with chronic suppurative otitis media, A sample of 100 patients of unilateral chronic suppurative otitis media was selected for the Study and their bone conduction thresholds Mere analyzed in relation to the duration of disease using audiometric data. A 24 per cent incidence of sensoineural hearing loss was found in this series, garticularly involving the higher frequencies. Moreover, the incidence of sensorineural hearing loss progressively increased with the increase in duration of chonic suppurative Ouns meadia     

Current opinion in the management in acute otitis media

The management of Acute otitis media has been a subject of controversy. This paper discusses the the current opinion on the subject including a review of recent literature. The use and choice of antibiotics reflects the wide variation in opinion for both first line and second-line therapy. The role of tympanocentesis and prophylactic treatment is discussed. The introduction of vaccines holds new promise on the prevention of Acute otitis media. Factors affecting outcome influence the management plan especially in recurrent cases, high risk groups and treatment failures.     

Lateral sinus thrombosis as a complication of chronic suppurative otitis media

18 cases of lateral sinus thrombosis are reported. All cases occured as a complication of attico-antral type of chronic suppurative otitis media. LST was found alone in 22.2% cases. LST was found associated with peri-sinus abscess (77.8%), meningitis (38.9%) and cerebellar abscess (16.6%). Surgical treatment consisted of radical mastoidectomy with incision of lateral sinus and suction of its contents in all cases; while in 16.7% cases sinuses were also obliterated after instituting free bleeding at LST site. Death occured in 5 cases (27.7%). The mortality for LST, while greatly reduced due to antibiotics, still remains significant.     

Acute myeloid leukemia in the elderly: a review

The diagnosis and management of acute myeloid leukemia (AML) in the elderly is reviewed, including the basic aspects of epidemiology, cytogenetics, and prognostic factors. AML at higher ages is associated with several unique biologic and clinical characteristics. It generally arise from an early level of hematopoietic stem cells, and has a particularly high incidence of poor prognostic karyotypes. Effective treatment of the elderly patient with AML remains a challenging task. The importance of therapeutic approaches and promising new drugs is summarized. Prospective randomized studies clearly demonstrate that elderly patients benefit from intensive induction therapy. Hematopoietic growth factors accelerate the recovery from treatment-induced neutropenia and may improve the outcome. In patients not eligible for intensive chemotherapy, prospective studies testing different palliative or moderately intensive treatments are needed to improve quality of life and survival. New treatment strategies need to be developed to further improve on the therapeutic perspectives for elderly patients with AML.